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Case Reports
. 2014 Feb 25;38(2):91-95.
doi: 10.3109/01658107.2013.874450. eCollection 2014.

Recurrent Optic Perineuritis after Intranasal Cocaine Abuse

S Coppens  1 , A Petzold  1 , P de Graaf  1 , W A E J de Vries-Knoppert  1
Affiliations
Case Reports

Recurrent Optic Perineuritis after Intranasal Cocaine Abuse

S Coppens et al. Neuroophthalmology. .

Abstract

Recurrent optic perineuritis can be related to orbital inflammation. Here we present the case of a 46-year-old male patient in whom recurrent episodes of optic perineuritis were related to chronic osteolytic sinusitis following intranasal cocaine abuse. Magnetic resonance imaging (MRI) demonstrated optic perineuritis adjacent to a soft tissue mass that intruded the orbit from the nasal cavity. Computed tomography (CT) confirmed destruction of the medial orbital wall. Staphylococcus aureus was cultured and biopsy showed granulomatous tissue. Visual outcome was poor. We review the literature and discuss the diagnostic pitfalls and management implications in relation to optic (peri)neuritis originating from the nasal sinuses.

Keywords: CT; Cocaine; MRI; histology; optic neuritis; optic perineuritis; osteolytic sinusitis.

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Figures

FIGURE 1
FIGURE 1
Axial (A) and coronal (B and C) contrast-enhanced T1-weighted MR images with fat suppression show a large soft-tissue mass invading the orbit from the nasal cavity (arrows) (A). The proximity of this soft-tissue mass to the left optic nerve is better appreciated on the coronal images (B and C). There is ring of contrast enhancement surrounding the left optic nerve borders without contrast enhancement of the optic nerve itself (arrow in B), which is suggestive of optic perineuritis. (D) Coronal computed tomography (CT) demonstrated destruction of the left medial orbital wall and some damage also to the right medial orbital wall. Bilaterally, the wall of the maxillary sinus is thickened and sclerotic due to chronic sinusitis.
FIGURE 2
FIGURE 2
Five years prior to admission, the patient presented to a different hospital for a similar problem. Scan alignment was not identical to those images shown in Figure 1. The closest approximation for the coronal CT (A) and the coronal contrast-enhanced T1-weighted MR images with fat suppression (B, C, and D) are presented. (A) CT scan shows the same large defect in the medial orbital wall on the left side. On the right side, CT imaging retrospectively suggests a small bone defect (arrow), which co-localises with the larger area of bone destruction seen in 2012 (compared with Figure 1D). Contrast enhancement of a comparable mass lesion invading the orbit through the destructed medial orbital wall was seen, without the particular signs of perineuritis on the left side (B). Profound enhancement is present in the right orbital apex (arrow in C), combined with an extensive dural enhancement at the anterior skull base, particularly on the right side (arrows in C and D). (D) A small degree of swelling of the right optic nerve is present.
FIGURE 3
FIGURE 3
Histology of the biopsy taken from the orbital infiltrate demonstrated inflammatory changes and granulation tissue (HE, ×100).
See this image and copyright information in PMC

References

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